Food and Water Insecurity in Panamanian Households: A Cross-Sectional Analysis

Abstract

Food and water security are essential components for Panama’s advancement toward the Sustainable Development Goals. This study aimed to quantify the prevalence of household food insecurity and water insecurity, and to explore the association between them using standardized measurement tools. A cross-sectional survey was conducted between January and June 2024 using an online questionnaire administered via Google Forms. The survey collected sociodemographic data and applied the Food Insecurity Experience Scale (FIES) and the Household Water Insecurity Experiences (HWISE) scale to assess water and food insecurity, respectively. A total of 222 adult household heads were included (66.2% female), with a median age of 31.4 years. The prevalence of moderate and severe food insecurity was 29.7% (95% CI: 24.8–34.6%) and 6.1% severe food insecurity (95% CI: 3.7–8.4%), while water insecurity affected 27% of households (10.4% high; 16.7% moderate). Multiple linear regression showed that moderate to severe food insecurity was significantly associated with water insecurity (β = 0.19; 95% CI: 0.08–0.31) and lower income levels. Specifically, food insecurity was associated with households reporting no income (β = 0.25; 95% CI: 0.05–0.44) and those with monthly income between 501 and 1000 USD (β = 0.11; 95% CI: 0.01–0.22), compared to households with income above 1000 USD. The results suggest that food insecurity is significantly associated with water insecurity, supporting the need for integrated approaches in public policy to address basic resource access in vulnerable populations.

1. Introduction

Ensuring food security is a critical global priority for achieving the Sustainable Development Goals (SDGs) and improving nutritional well-being and public health [1,2]. According to the FAO’s 1996 World Food Summit, food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life [3]. This definition highlights the multidimensional nature of food security, encompassing availability, access, utilization, and stability. Food insecurity contributes to both undernutrition and overnutrition. On one hand, it leads to chronic hunger, stunting, and wasting, particularly in vulnerable populations such as children [4,5]; on the other hand, it is associated with poor dietary quality and increased risk of overweight, obesity, and non-communicable chronic diseases (NDC) [6,7,8], as households facing economic constraints often rely on inexpensive, energy-dense foods. This context also highlights the need for comprehensive and context-specific public policy strategies to ensure food security and address all forms of malnutrition, particularly among the most vulnerable population [9].

Between 2022–2024, an estimated of 685.6 million people were classified as undernourished, and more than 2.28 billion individuals experienced moderate or severe food insecurity [10]. Globally, 149 million children under five years of age were stunted, 45 million suffered from wasting, and 39 million were overweight [5]. In Latin America and the Caribbean (LAC), approximately 35 million people are affected by hunger and 179.8 million by moderate or severe food insecurity [10]. These conditions are particularly prevalent in indigenous communities and in households headed by women, reflecting persistent structural inequalities that limit progress toward achieving the SDG, especially SDG #2 zero hunger [10].

In Panama, the prevalence of hunger has declined significantly, from 14.8% in 2004–2006 to 5.7% in 2022–2024, yet approximately 200,000 people still live in conditions of hunger [10]. Compared to countries like Chile, Uruguay, Costa Rica, and more recently Brazil, which have exited the FAO’s hunger map, Panama shares a trajectory of marked economic growth [11]. However, persistent inequalities and gaps in access to nutritious food remain, underscoring the need for targeted public policies. Recent non-representative studies conducted in Panama indicate that food insecurity ranges between 19% and 37.8% [12,13]. Stunting in children under five has declined from 22% in 2003 to 15.8% in 2019, and overnutrition has increased, with 13% of children under five, 36% of school-aged children and adolescents, and 71.7% of adults classified as overweight or obese [14]. Tackling these issues requires consideration of broader sustainability concerns and the growing influence of climate change on food systems [10].

A recent review highlights that water insecurity may be a stronger driver of food insecurity, directly impacting the health and well-being of the population [15]. Water insecurity is also a major concern in the region, with estimates indicating that between 16% and 48% of the population in LAC experiences limited or uncertain access to adequate water resources [16]. Water scarcity impacts agricultural productivity, reduces food availability, and undermines nutrition, health, and the fulfillment of basic human needs [17,18]. Furthermore, increasing water stress driven by population growth, pollution, and climate variability compromises both the quantity and quality of water available for household and productive uses [19].

Recent research has established a strong and consistent link between food insecurity and water insecurity [15,16]. An analysis of Mexico’s 2021 National Health and Nutrition Survey found that households experiencing water insecurity were 2.35 times more likely to suffer from moderate or severe food insecurity [20]. A major study collecting data from 25 low and middle-income countries found that individuals experiencing water insecurity were nearly three times as likely to also face food insecurity, with more than two-thirds of water-insecure respondents concurrently experiencing food insecurity [17]. This association was high across diverse regions, including Asia, LAC, North Africa, and sub-Saharan Africa, even after adjusting for socioeconomic factors. Further, household-level analyses indicate that water insecurity, including issues of quantity, quality, and access directly contributes to reduced food availability, lower food quality, and increased anxiety about food, suggesting that water insecurity is a strong driver of food insecurity rather than only a coexisting condition [21,22]. Water insecurity has been associated with mental, physical, and food-related stress, highlighting the need to address these interconnected dimensions in public policy [18]. However, there is limited evidence on the predictive capacity of current tools to assess the future state of global food and water security [23]. In LAC, and particularly in Panama, the relationship between these two forms of insecurity remains understudied. Therefore, the main objective of this study is to examine the association between food insecurity and water insecurity in Panama. A secondary objective is to estimate the prevalence of both conditions at the household level, given the absence of previous national data on food and water insecurity. The findings aim to inform the development of integrated strategies that simultaneously address food and water challenges in support of sustainable development.

2. Materials and Methods

2.1. Study Design and Data Collection

This cross-sectional study was conducted using an online questionnaire administered via Google Forms between January and June 2024. It forms part of a multicenter research project aimed at validating a household water insecurity scale in LAC [24]. The study was implemented by the School of Food and Nutritional Security of the Specialized University of the Americas and the School of Nutrition and Dietetics of the University of Panama.

2.2. Participants and Sample

The target population consisted of adult household heads residing in Panama. The sample size was calculated based on two independent prevalence estimates, food insecurity at 28.3% [25] with 95% confidence level and 6% precision (n = 216), and water insecurity at 16% [16] with 5% precision (n = 207). This choice reflects differences in expected variability based on prior studies, as well as practical considerations related to sample size and logistical constraints. To ensure adequate statistical power, the final sample included 222 participants. Non-probabilistic convenience sampling was applied using a snowball method. Recruitment was conducted via social media, email, and personal contacts. Each participant was invited to share the survey with other eligible household heads. Inclusion criteria were being aged 18 years or older and having resided in the household for at least six months.

2.3. Questionnaire, Instruments and Measures

The structured questionnaire consisted of three sections. The first section collected sociodemographic data, including sex, age, household composition, income, employment status, access to social protection, and household connection to public water and electricity services. Access to public water was defined as connection to a formal water distribution system, without assumptions regarding quality or reliability.

The second section included two validated scales. The Food Insecurity Experience Scale (FIES) comprises eight questions on food access and behaviors over the previous 12 months, capturing food-related experiences caused by resource constraints [21]. Responses are dichotomous (yes = 1, no = 0), and households were classified into levels of food insecurity using the standard FAO methodology [26]. The FIES data were analyzed using the Rasch model, which estimates the probability of a household experiencing moderate or severe food insecurity. This method accounts for the severity continuum of food insecurity by considering the pattern and number of affirmative responses across the eight FIES items. The analysis was conducted using the FAO’s official tool for FIES data processing (https://fies.shinyapps.io/ExtendedApp/ last accessed on 13 November 2024), which enables standardized classification and comparability across contexts. Probabilities of experiencing moderate or severe food insecurity, as well as severe-only food insecurity, were calculated and reported as proportions with 95% confidential interval (95% CI). Following FAO recommendations, only the probabilities of experiencing moderate or severe food insecurity, as well as severe-only food insecurity, are reported. The categories of “food secure” and “mild food insecurity” are not directly estimated by the Rasch model and can only be inferred by difference, which is not recommended due to potential methodological inaccuracies [27].

The Household Water Insecurity Experiences Scale (HWISE) consists of 12 items assessing access to water for consumption, food preparation, and domestic use in the past four weeks [28,29]. Items are scored from 0 (never) to 4 (always). Households were considered water insecure if they reported experiencing at least six of the 12 items “sometimes” or more frequently in the past month. A complementary severity classification was also applied: 0–2 points (no-to-marginal), 3–11 (low), 12–23 (moderate), and 24–36 (high insecurity) [30]. All questions were multiple choice, and the average completion time was 10 min. The questionnaire underwent content validation by four academic experts, followed by comprehension testing through a pilot application with 16 participants. Revisions were incorporated to improve clarity and readability. The final version of the questionnaire is available in Spanish as Supplementary Material.

2.4. Ethical Considerations

Participation was anonymous and voluntary. No personally identifiable data were collected. Prior to participation, all respondents received an explanation of the study objectives, risks, and benefits and provided informed consent through the survey platform. The study was registered with the Ministry of Health of Panama and approved by the Bioethics Committee of the University of Panama (Reference No. CBUP/155/2024).

2.5. Statistical Analysis

Data were analyzed using Stata version 16.1 (StataCorp, College Station, TX, USA). Descriptive statistics were used to summarize categorical variables (frequencies, percentages, 95% CI) and continuous variables (means with standard deviations, 95% CI). Chi-square tests were used for categorical comparisons, and independent Student’s t-tests or ANOVA and Bonferroni post hoc test for continuous variables. A multiple linear regression model was used to evaluate the association between moderate to severe food insecurity with water insecurity and selected sociodemographic data. The covariates included in the model, such as sex and age, were retained based on theoretical relevance and consistency with prior literature [31]. Results are presented as beta coefficients (β) and 95% CI, with statistical significance set at p < 0.05.

3. Results

A total of 222 individuals aged between 18 and 78 years responded to the questionnaire, with 66.2% being female. The mean and SD for age were 35.8 ± 13.3 years. Of the total sample, 48.2% were between 18 and 30 years old, and 30.2% were 41 years or older. Most participants (86.5%) resided in urban areas, and 83.3% reported having technical, university, or postgraduate education levels. Regarding household income, 52.7% reported monthly earnings above 1000 USD, 60.8% reported fixed salaries, and 24.3% were unemployed. Social assistance (cash or food-based) was received by 17.6% of respondents. Regarding household composition, 56.5% reported having children or adolescents. Most households reported access to public water (95%) and electricity (99.5%) infrastructure.

Table 1. Participant characteristics.

Variable 1	Category	Frequency	Percentage (%)
Gender	Female	147	66.2%
Age Range	18–30 years	107	48.2%
	31–40 years	48	21.6%
	41 years or older	67	30.2%
Residence Area	Urban	192	86.5%
	Rural	30	13.5%
Education	Up to secondary school	37	16.7%
	Technical, university, or higher	185	83.3%
Religion	Catholic	119	53.6%
	Christian	74	33.3%
	None	17	7.7%
	Other	12	5.4%
Nationality	Panamanian	216	97.3%
	Foreigner	6	2.7%
Household Income (USD/month)	No income	23	10.4%
	<500	19	8.6%
	501–1000	63	28.4%
	>1000	117	52.7%
Employment Status	Unemployed	54	24.3%
	Fixed salary	135	60.8%
	Self-employed/daily worker	33	14.9%
Marital Status	Married/in union	107	48.2%
	Single/divorced/widowed	115	51.8%
Social Assistance	No	183	82.4%
	Yes	39	17.6%
Number of People in Household	1 person	16	7.2%
	2 people	46	20.7%
	3 people	48	21.6%
	4 people	52	23.1%
	5 or more people	60	27.0%
Presence of children or adolescents	No	97	43.5%
	Yes	126	56.5%
	Yes	90	40.5%
Pregnant Women in Household	No	217	97.8%
	Yes	5	2.3%
Infants in Household	No	190	85.6%
	Yes	32	14.4%
Access to Potable Water	No	11	5.0%
	Yes	211	95.0%
Electricity	No	1	0.5%
	Yes	221	99.5%

¹ Data presented as frequency and percentages.

summarizes the main characteristics of the participants.

Table 2. Frequency and percentage of “yes” and “no” responses for each item of the Food Insecurity Experience Scale (FIES).

FIES Item 1	No	Yes
1. You were worried you would not have enough food to eat?	132 (59.5%)	90 (40.5%)
2. You were unable to eat healthy and nutritious food	129 (58.1%)	93 (41.9%)
3. You ate only a few kinds of foods?	133 (59.9%)	89 (40.1%)
4. You had to skip a meal?	163 (73.4%)	59 (26.6%)
5. You ate less than you thought you should?	155 (69.8%)	67 (30.2%)
6. Your household ran out of food?	192 (86.5%)	30 (13.5%)
7. You were hungry but did not eat?	153 (68.9%)	69 (31.1%)
8. You went without eating for a whole day?	203 (91.4%)	19 (8.6%)

¹ Data presented as frequency and percentages.

presents the frequency and percentage of “yes” and “no” responses for each of the eight items of FIES. The proportion of affirmative responses ranged from 8.6% for the item “went without eating for a whole day” to 41.9% for “unable to eat healthy and nutritious food.” All items are reported individually with corresponding frequencies and percentages.

Table 3. Food and water insecurity evaluation.

Food/Water Insecurity 1	Proportion	95%CI
Moderate and severe food insecurity	29.7%	24.8–34.6%
Severe food insecurity	6.1%	3.7–8.4%
Water insecurity	27%	21.3–33.4%
No-to-marginal water insecurity	39.2%	32.7–45.9%
Low water insecurity	33.8%	27.6–40.4%
Moderate water insecurity	16.7%	12.0–22.2%
High water insecurity	10.4%	6.7–15.1%

¹ Data presented as percentages and 95% confidential interval (CI).

presents the percentage and 95%CI of food and water insecurity using FIES and HWISE. The proportion and 95%CI for moderate and severe food insecurity were 29.7% (95% CI: 24.8–34.6%), while severe food insecurity alone was reported in 6.1% (95% CI: 3.7–8.4%). Among the classifications, 39.2% (87/222) of households were categorized as having no-to-marginal insecurity, 33.8% (75/222) as low insecurity, 16.7% (37/222) as moderate insecurity, and 10.4% (23/222) as high insecurity. When combining moderate and high insecurity, 27.1% (60/222) of households were considered water insecure.

Table 4. Comparison of water insecurity vs. sociodemographic variables.

Variable	Food Insecurity	p *	Water Insecurity	p *
Gender
Male	24.6 ± 33.6%	0.1399	13 (17.6%)	0.025
Female	32.4 ± 38.6%		47 (31.8%)
Age category
18–30 years	34.0 ± 37.4%	0.0578	29 (27.1%)	0.680
31–40 years	32.7 ± 40.2%		15 (31.3%)
41+ years	20.7 ± 33.2%		16 (23.9%)
Residence area
Urban	28.3 ± 35.9%	0.1421	52 (27.1%)	0.962
Rural	39.0 ± 43.8%		8 (26.7%)
Education
Up to secondary	45.1 ± 42.0%	0.0055	11 (29.7%)	0.685
Higher education	26.6 ± 35.4%		49 (26.5%)
Religion
Believer	29.7 ± 75.5%	0.6705	54 (27.5%)	0.617
None	34.4 ± 37.7%		3 (17.6%)
Other	20.7 ± 37.7%		3 (33.3%)
Monthly income (USD)
No income	56.1 ± 40.9% a	<0.001	9 (39.1%)	0.068
<500 USD	41.0 ± 43.8% a,b		6 (31.6%)
501–1000 USD	37.3 ± 38.9% a		22 (34.9%)
>1000 USD	18.6 ± 29.7% b		23 (19.7%)
Employment status
Fixed salary	26.3 ± 35.9% a	0.0003	37 (27.4%)	0.177
Self-employed/daily worker	16.8 ± 27.3% a		5 (15.1%)
Unemployed	46.1 ± 40.3% b		18 (33.3%)
Marital status
Married/in union	27.9 ± 36.6%	0.4826	32 (29.9%)	0.351
Single/widowed/divorced	31.4 ± 37.6%		28 (24.4%)
Social protection
No	28.3 ± 36.4%	0.2069	45 (24.6%)	0.077
Yes	36.5 ± 40.2%		15 (38.5%)
Presence of children or adolescents
No	22.8 ± 33.0%	0.0146	25 (41.7%)	0.7110
Yes	35.0 ± 39.3%		35 (58.3%)
School-aged Children at home	122 (74.9%)		41 (25.2%)	0.296
No
Yes	40 (67.8%)		19 (32.2%)
Adolescents at home
No	101 (76.5%)		31 (23.5%)	0.150
Yes	61 (67.8%)		29 (32.2%)
Access to water
No	67.0 ± 44.3	0.0006	8 (72.7%)	<0.001
Yes	27.8 ± 35.8		52 (24.6%)

Data presented as frequency and percentage (%) for water insecurity and mean and standard deviation for food insecurity. * The p-value corresponds to the Chi-square test for water insecurity, independent Student’s t-test or ANOVA and lowercase vowels correspond to the Bonferroni test for food insecurity.

presents the comparison between food and water insecurity with sociodemographic variables. Statistically significant disparities in food insecurity were observed across for education, income, income, employment status and access to water service. Individuals with up to secondary education exhibited a higher prevalence of food insecurity (45.1% ± 42.0) compared to those with higher education (26.6% ± 35.4) (Student’s t-test; p = 0.0055). Monthly income also showed significant differences, with food insecurity rates decreasing as income increased: no income (56.1% ± 40.9), less than $500 (41.0% ± 43.8), $501–$1000 (37.0% ± 38.9), and greater than $1000 (18.0% ± 29.7) (ANOVA with Bonferroni post hoc test; p < 0.001). Employment status was significantly associated with food insecurity, with unemployed individuals reporting the highest prevalence (46.0% ± 40.3), followed by those with fixed salaries (26.0% ± 35.9), and self-employed or daily workers (16.0% ± 27.0) (ANOVA with Bonferroni post hoc test; p = 0.0003). Households with children or adolescents experienced higher food insecurity (35.0% ± 39.3) compared to those without (22.0% ± 33.0) (Student’s t-test; p = 0.0146). Access to potable water also showed a significant difference, with individuals lacking access reporting higher food insecurity (67.0% ± 44.3) than those with access (27.0% ± 35.8) (Student’s t-test; p = 0.0006).

Regarding water insecurity, statistically significant disparities were found for gender and access to potable water. Households lacking potable water services exhibited a markedly higher prevalence of water insecurity (72.7%; 8/11) compared to those with access (24.6%; 52/211) (Chi-square test; p < 0.001). Gender also showed a significant difference, with women experiencing higher water insecurity (31.8%; 47/147) than men (17.6%; 13/75) (Chi-square test; p = 0.025).

Figure 1 shows the proportions of moderate and severe food insecurity in relation to household water insecurity status. Among households without water insecurity (n = 162), the prevalence of moderate and severe food insecurity was 23.2% (95% CI: 18.1–28.2%). In contrast, households experiencing water insecurity (n = 60) had a significantly higher prevalence of moderate and severe food insecurity of 47.4% (95% CI: 36.3–58.5%) (independent Student’s t-test; p < 0.0001).

Figure 2 presents the β coefficients and 95%CI obtained from a multiple linear regression model assessing the association between moderate to severe food insecurity with water insecurity and various sociodemographic characteristics. The model includes adjustment for sex and age. Moderate to severe food insecurity was significantly associated with water insecurity (yes vs. no; β = 0.22; 95% CI: 0.10–0.335), educational level (up to secondary vs. higher education; β = 0.17; 95% CI: 0.03–0.301), and employment status (unemployed vs. salaried/self-employed or day laborer; β = 0.17; 95% CI: 0.04–0.295).

4. Discussion

This study examined the association between household food insecurity and water insecurity in Panama. In the present study, 29.7% of participants experienced moderate or severe food insecurity, and 27.1% experienced water insecurity. People experiencing water insecurity were 22% more likely to be experiencing moderate or severe food insecurity. Food insecurity was also associated with educational level and employment status. Individuals with lower education and those who were unemployed had a 17% higher likelihood of experiencing moderate or severe food insecurity.

Recent studies in Panama have reported varying prevalence rates of moderate and severe food insecurity ranging from 19% in university populations to 37.8% in community-based samples [12,13]. The prevalence observed in this study aligns with the regional average of 28.3% reported by FAO for Latin America and the Caribbean [25]. Compared to neighboring countries, Panama’s food insecurity levels appear higher than those of Costa Rica and Belize, and more similar to those of Honduras and Guatemala. In Mexico, Arriaga-Ayala et al. found a 24.3% prevalence of moderate and severe food insecurity among overweight women, and reported a significant association between food insecurity and overweight/obesity, highlighting the role of structural determinants [31].

A multicenter study conducted during the COVID-19 pandemic, which included Panama, reported a 16.5% prevalence of moderate and severe food insecurity in the country, associated with low education, rural residence, informal employment, and large household size [32]. While lower than the proportion observed in this study, the difference may reflect the impact of containment measures and differences in sampling strategies. More importantly, our findings add new evidence by demonstrating a significant association between food insecurity and water insecurity, suggesting that access to reliable water services may be a critical but overlooked determinant of food security in the country. This underscores the need for integrated approaches to address overlapping vulnerabilities in Panama and the region.

Similarly, our findings show that moderate and severe food insecurity is significantly associated with water insecurity, as well as with lower education and employment status. These associations reinforce the multidimensional nature of food insecurity and its intersection with other social vulnerabilities in the region. Comparative studies on water insecurity in the region confirm similar patterns. For instance, Melgar-Quiñonez et al. reported water insecurity prevalence of 16.5% in Mexico, 24.2% in Guatemala, 47.2% in Honduras, and 48.2% in Peru [16]. In Panama, our study identified 27% of households as water insecure, placing the country between Guatemala and Honduras. This is a significant finding, as national data on water insecurity remain scarce, and our results provide one of the first empirical estimates for Panama. Although most households reported access to public water systems, this access was often unreliable due to frequent interruptions and poor service continuity. These findings are consistent with those of Ray et al., who argue that intermittent service reduces water security and disproportionately affects vulnerable populations [33]. By documenting the prevalence and nature of water insecurity in Panama, this study contributes critical evidence to regional discussions on the intersection between water access, infrastructure reliability, and social vulnerability. Moreover, the observed association between water insecurity and food insecurity underscores the need for integrated approaches to address basic needs and improve resilience in the face of climate and economic stressors.

Several factors help explain the link between water and food insecurity, including intermittent water supply, extreme climate events, household dynamics, and gender disparities [15]. Findings consistent with those findings reported in this study, Broyles et al. found a strong association between water and food insecurity among Tsimane’ indigenous households in Bolivia, where water insecurity increased the risk of severe food insecurity by 43% [34]. Similarly, studies from Mexico and Brazil have documented high co-occurrence of both forms of insecurity, particularly among female-headed and indigenous households [35,36]. Likewise, in Mexico, water insecurity increased the risk of moderate and severe food insecurity by 2.35 times, and both insecurities were more prevalent among indigenous and rural populations [20]. These studies reinforce the need to measure and address water insecurity alongside food insecurity in public health and policy efforts.

In Panama, several strategic plans address food and water security. The National Food Security and Nutrition Plan is led by the Secretariat for the Implementation of the Plan (SENAPAN), a body attached to the Ministry of Social Development, which coordinates food and nutrition security through a multisectoral approach. The National Food Security Plan focuses on improving nutrition and reducing undernutrition throughout the food system [37]. The National Water Security Plan (2015–2050) and the Integrated Water Resource Management Action Plan (2022–2026) aim to expand access to safe water and sanitation and promote sustainable water use [38]. However, the effectiveness of these plans depends on intersectoral coordination, legal frameworks, and the availability of updated data on water and food insecurity across all population groups.

We acknowledge limitations in the representativity of the sample, particularly regarding the inclusion of rural and indigenous populations. Due to logistical and resource constraints, expanding the sample to include these groups was not feasible. Future studies should prioritize more diverse and inclusive sampling strategies, such as mixed-method or in-person approaches, to minimize selection bias and enhance the generalizability of findings. The use of a non-probabilistic, online sampling method may have introduced selection bias, for example, excluding rural and indigenous populations with limited internet access. Additionally, the cross-sectional design prevents establishing causal relationships. Another limitation is the difference in reference periods between the food insecurity (FIES, 12 months) and water insecurity (HWISE, 4 weeks) scales, which may affect the interpretation of their association. Future studies should consider adapting the HWISE tool to a 12-month reference period, as has been done in other international research, to improve analytical consistency and comparability.

Nonetheless, the study presents important strengths. It is among the first in Panama to explore the relationship between food and water insecurity and applies validated measurement instruments. The use of multivariate statistical models strengthens the robustness of the findings and offers valuable evidence for policy development. Several factors such as climate variability, the adequacy of infrastructure, and gender dynamics are expected to be linked to food and water insecurity in Panama. For example, climate-related events can simultaneously disrupt water availability and agricultural productivity, while inadequate infrastructure may exacerbate access challenges. Gender roles and responsibilities, particularly in resource collection and household management, further influence vulnerability and adaptation strategies. These factors likely interact to influence household vulnerability and deserve deeper investigation using longitudinal or mixed-methods studies. Finally, we suggest that future work could benefit from a closer analysis of national policy frameworks, such as the current implementation status of Panama’s food and water security plans.

Future research should include rural and indigenous communities and consider mixed methods to better understand the lived experience of food and water insecurity. National health surveys in Panama should integrate water insecurity modules to improve monitoring and guide targeted interventions. Addressing these challenges will require coordinated efforts across sectors such as health, education, agriculture, and environment, and should be informed by the growing evidence linking water insecurity to nutritional, social, and economic vulnerability [39].

5. Conclusions

This study shows that food and water insecurity are closely linked in Panamanian households. Food insecurity was associated with low household income, while water insecurity was related to limited access to potable water and a higher probability of experiencing moderate and severe food insecurity. These findings underscore the value of using experience-based tools to assess water insecurity and the need to consider the multiple dimensions of both phenomena. The results support the integration of food and water security into public policies to address basic needs in a coordinated manner, particularly in vulnerable populations. Although this study contributes to a relatively unexplored area in Panama, future research with representative samples is needed to strengthen the evidence base and evaluate the effectiveness of targeted interventions. Advancing this agenda is essential for improving population well-being and achieving the Sustainable Development Goals.